Patient and clinical characteristics associated with pain during cesarean delivery: a prospective single-center patient-reported outcome study

Introduction: There are multiple variables known to be associated with pain during cesarean delivery (PDCD), including patient-related factors, obstetrical and surgical factors, and anesthetic technique. The primary aim of this prospective patient-reported outcome study was to evaluate patient-related factors, including expectations and anxiety, and clinical variables associated with PDCD. Methods: Patients undergoing cesarean delivery from December 1, 2023 to March 31, 2024 were enrolled 24 to 72 hours postoperatively. They completed the STAI-6 anxiety survey, a 13-item catastrophizing survey, a question about expected PDCD, and reported PDCD on a 0-100 mm visual analog scale (VAS). We defined PDCD as a VAS score >= 30 mm. Demographic, physical, and clinical data were retrieved from the electronic medical record. Results: There were 110 recruited patients with 40 (36%) reporting PDCD. Patients who had PDCD differed in race, surgical duration, and administration of supplemental systemic analgesic medication. A multivariate logistic regression identified that surgical duration, history of anxiety, intrapartum activation of epidural (versus spinal or combined spinal epidural) and Black race (versus White) were associated with PDCD. There were 33 (30%), 48 (44%), 14 (13%), 7 (6%), and 7 (6%) patients who reported no pain, pain less than expected, pain that was expected, more pain than expected, and much more pain than expected during their cesarean delivery, respectively. Conclusions: In our cohort with a high reported PDCD rate, potentially modifiable variables associated with PDCD were initial anesthetic technique and surgical duration. A concerning finding was that most patients reported some level of PDCD.